髋关节翻修术中3D打印金属骨小梁垫块重建髋臼的近期疗效  

Short-term effectiveness of acetabular reconstruction with three-dimensional printed trabecular metal pads in hip revision

作　　者：张钟元 赵锦伟 黄相杰 江和训 徐梓耀 ZHANG Zhongyuan;ZHAO Jinwei;HUANG Xiangjie;JIANG Hexun;XU Ziyao(Department of Bone and Joint,Wendeng Orthopedic Hospital of Shandong Province,Weihai Shandong,264400,P.R.China)

机构地区：[1]山东省文登整骨医院骨关节科

出　　处：《中国修复重建外科杂志》2019年第12期1516-1520,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨髋关节翻修术中采用3D打印金属骨小梁垫块修复PaproskyⅢ型髋臼骨缺损、重建髋臼的近期疗效。方法 2014年8月-2015年12月,于5例初次髋关节翻修术中采用3D打印金属骨小梁垫块修复PaproskyⅢ型髋臼骨缺损、重建髋臼环形结构。男3例,女2例;年龄50~72岁,平均66岁。初次置换至翻修术时间为10~18年,平均14.4年。初次置换假体类型:非骨水泥型3例,骨水泥型2例。髋臼骨缺损分型:PaproskyⅢA型3例、ⅢB型2例。术前Harris评分为(34.23±11.67)分。患髋旋转中心高度为(38.17±8.87)mm、水平位置为(35.62±9.12)mm。结果手术时间120~180 min,平均142 min;术中出血量800~1 700 mL,平均1 100 mL。5例患者均获随访,随访时间18~24个月,平均21个月。末次随访时,髋关节Harris评分为(79.82±8.70)分,较术前明显提高(t=16.991,P=0.000)。术后1周X线片测量髋臼杯外展角为38~42°,平均39.4°;前倾角为13~18°,平均14.6°。患侧髋关节旋转中心高度为(22.08±8.33)mm、水平位置为(29.03±6.28)mm,与术前比较差异均有统计学意义(P<0.05);与健侧髋关节(28.62±7.73)、(27.29±4.22)mm比较,差异均无统计学意义(P>0.05)。随访期间均无假体松动、脱位及假体周围骨折等并发症发生。结论髋关节翻修术中应用3D打印金属骨小梁垫块修复PaproskyⅢ型髋臼骨缺损,可重建髋臼环形结构,为髋臼杯提供稳定支撑结构,重建相对正常的髋关节旋转中心,避免医源性骨量丢失,髋关节功能恢复满意,远期疗效有待进一步随访。Objective To investigate the short-term effectiveness of three-dimensional(3 D) printed trabecular metal pads for Paprosky type Ⅲ acetabular defect in hip revision. Methods Between August 2014 and December 2015,the 3 D printed trabecular metal pads were used to repair Paprosky type Ⅲ acetabular defects and reconstruct the annular structure of the acetabulums in 5 cases of primary hip revision. There were 3 males and 2 females, aged from 50 to 72 years, with an average age of 66 years. The time from initial replacement to revision was 10 to 18 years, with an average of14.4 years. The types of prostheses in primary replacement were non-cemented in 3 cases and cemented in 2 cases. The types of acetabular bone defects were Paprosky type ⅢA in 3 cases and Paprosky type ⅢB in 2 cases. The preoperative Harris score was 34.23±11.67. The height of rotation center of affected hip was(38.17±8.87) mm and the horizontal position was(35.62±9.12) mm. Results The operation time was 120-180 minutes, with an average of 142 minutes. The intraoperative bleeding volume was 800-1 700 mL, with an average of 1 100 mL. Five patients were followed up 18-24 months(mean, 21 months). At last follow-up, the Harris score was 79.82±8.70, which was significantly higher than that before operation(t=16.991, P=0.000). At 1 week after operation, the abduction angle of acetabular cup was 38-42°(mean,39.4 °) and the anteversion angle was 13-18 °(mean, 14.6°). The height and horizontal position of rotation center of affected hip were(22.08±8.33) mm and(29.03±6.28) mm, respectively, showing significant differences when compared with those before operation(P<0.05);there was no significant difference when compared with those of healthy hip[(28.62±7.73),(27.29±4.22) mm](P>0.05). During the follow-up, there was no complication such as prosthesis loosening,dislocation, or periprosthetic fracture. Conclusion In hip revision, 3 D printed trabecular metal pads can repair Paprosky type Ⅲ acetabular defect, reconstruct the structure of aceta

关 键 词：髋关节 翻修术 骨缺损 髋臼 3D打印 

分 类 号：R68[医药卫生—骨科学]